Brachioradial Pruritus Clinical Presentation

  • Author: Julianne Mann, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 21, 2010
 

History

The itch of brachioradial pruritus is described as intense, burning, and prickling. It is localized to the dorsolateral aspects of the bilateral upper arms, forearms, and shoulders. Scratching is reported to make the discomfort worse, and many patients find that the only therapy that brings relief is the application of ice packs or cold, wet towels.[3, 7, 19] The discomfort is typically worse at night and, for some patients, may interfere with falling asleep.[4] The median duration of symptoms has been reported as 4.5 years,[2] but patients have reported a continuation of symptoms from this condition for as long as 18 years.[1]

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Physical

Despite the severity of symptoms, no associated erythema or skin eruption is seen. Evidence of excoriation or lichenification may be present in the affected areas.

Altered sensation to pinprick and temperature in the distribution of the posterior cutaneous nerve of the forearm, which supplies the skin over the proximal brachioradialis muscle, may be observed.[6] Pronounced heat hyperalgesia in the C5 and C6 dermatomal distribution[7] and pinprick hyperesthesia in the C5-C8 distribution[8] may be seen.

Area of pruritus demarcated in pen in a middle-ageArea of pruritus demarcated in pen in a middle-aged woman with brachioradial pruritus. Macroscopically, no skin changes are visible. Subtle excoriations on the dorsal forearm of a midSubtle excoriations on the dorsal forearm of a middle-aged woman with brachioradial pruritus.
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Causes

Exposure of the affected areas to sun and wind may precipitate an episode, as may radiculopathy of the cervical spine. These are speculative, and the authors believe the etiology is multifactorial. In some cases, an emotional component to the symptoms seems apparent.

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Contributor Information and Disclosures
Author

Julianne Mann, MD  Resident Physician, Department of Dermatology, Oregon Health and Science University

Julianne Mann, MD is a member of the following medical societies: Alpha Omega Alpha and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

David J Elpern, MD  Consulting Staff, The Skin Clinic

David J Elpern, MD is a member of the following medical societies: American Academy of Dermatology and Hawaii Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jacek C Szepietowski, MD, PhD  Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Stiefel GSK Company Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting; Abbott Consulting fee Consulting

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Area of pruritus demarcated in pen in a middle-aged woman with brachioradial pruritus. Macroscopically, no skin changes are visible.
Subtle excoriations on the dorsal forearm of a middle-aged woman with brachioradial pruritus.
 
 
 
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